Current management of uveitis-associated ocular hypertension and glaucoma

• Published in: Survey of ophthalmology 2020-07, Vol.65 (4), p.397-407
• Main Authors: Kesav, Natasha, Palestine, Alan G., Kahook, Malik Y., Pantcheva, Mina B.
• Format: Article
• Language: English
• Subjects: corticosteroid; glaucoma; glaucoma surgery; intraocular pressure management; ocular hypertension; uveitis
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2019.12.003

Glaucoma secondary to ocular inflammation is potentially blinding and requires aggressive multifaceted management. The pathogenesis is related to the intraocular pressure elevation secondary to compromised aqueous humor outflow by inflammatory cells, chemical mediators released into the aqueous, and to the uveitic therapy itself (corticosteroid induced). The management of uveitic glaucoma needs a careful combination between anti-inflammatory therapy and appropriate intraocular pressure–lowering drugs to prevent worsening of condition and long-term visual loss. Although there have been novel medications that have emerged in the management of glaucoma and uveitis, around 30% of uveitic glaucoma eyes do not respond to maximal medical therapy and require surgical intervention. Studied procedures include laser therapy, filtration surgery, and glaucoma drainage devices, as well as recent surgical techniques for intraocular pressure control such as minimally invasive glaucoma surgery and angle-based procedures. We review and update the medical and surgical management of uveitic glaucoma.